JOURNAL

READING
RELATIONSHIP OF FETUIN A WITH
GLOMERULAR FILTRATION RATE
& ENDOTHELIAL DISFUNCTION IN
MODERATE-SEVERE CKD

Oleh
Anugrah Maya Purwa Irianti Dewi

Pembimbing
Dr. dr Bambang Purwanto, SpPD KGH FINASIM

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 BACKGROUND

FETUIN A

• Inhibitor of vascular and soft tissue

calcification
• Negative acute phase protein

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 BACKGROUND

End Stage Renal Disease

Lower of Fetuin A

Impact to Cardiovascular mortality

3
 BACKGROUND

Caglar
Caglar et
et al
al::
Fetuin
FetuinAA  contributing
contributingfactor
factor for
for endothelial
endothelial
disfunction
disfunctionininCKD
CKD

Fetuin
Fetuinaalevel
levelsignificantly
significantlyincreased
increasedafter
afterrenal
renal
transplantation.
transplantation.

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 AIM OF THE STUDY

To analyze the relationship between

Fetuin A & renal function

To analyze the correlation of Fetuin A

With the biomarker of endothelial
dysfunction ET-1 and with the inflammatory
Cytokine IL-6
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 METHODS

Subject : Chronic Kidney Disease patient

which confirmed with KDOQI
classification and calculation of GFR
with MDRD formula

108 patients :

• 40 CKD stage III

• 38 CKD stage IV
• 30 CKD stage V
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 METHODS

• smoking
• previous stroke / TIA
• previous angina/ AMI
• Cardiac failure
• hepatic dysfunction
• other major
noncardiovascular
disease

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 Laboratory Methods

After fasting over night :

• Plasma levels of Fetuin A, ET-1, IL-6 
ELISA
• Routine blood chemistry

8
 Statistical Analysis

To analyze the differences between groups 

ANOVA and Student T test

To analyze the association between variables

 Simple & multiple regression

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12
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14
15
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 DISCUSSION

Fetuin
FetuinAA independently
independently&&directly
directlyassociated
associated
with
withGFR  significant
GFR  significant decrease
decreaserelated
related to
to
decreasing
decreasingGFR
GFR

The
Thehigher
higherthe
thelevels
levelsof
ofFetuin
FetuinAA the
thelower
lower the
the
ET-1
ET-1&&IL-6
IL-6levels  inversely
levels  inverselycorrelated
correlated

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 DISCUSSION

Reduced
Reducedlevelsof
levelsofFetuin
FetuinAAas
ascalcification
calcificationinhibitors
inhibitors
 increased
 increasedvascular
vascularsmooth
smooth muscle
musclecells
cells
calcification
calcification

ET-1
ET-1independently
independentlyassociated
associated with
withfetuin
fetuinAA

significantly
significantlyincrease
increasein
in relation
relationto
todecrease
decreaseof
of
Fetuin
FetuinAA

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 DISCUSSION

Endothelial
Endothelialdisfunction  worsened
disfunction  worsened when
whenFetuin
FetuinAA
decreased
decreased

IL-6
IL-6inversely
inverselyand
andindependent
independentcorrelated
correlatedwith
with
fetuin
fetuinAA proatherogenic
proatherogenicinflammatory
inflammatoryactivation
activation
even
evenininmoderate
moderateCKD
CKD

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 CONCLUSSION

All the result in this study  indicate that in CKD

Even not in severe stage  inflammatory process are
Increased and associated with endothelial dysfunction
 Worsening progressively renal function

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 Penilaian Ya Tidak
Judul : singkat, menarik, menggambarkan isi √
utama
Pengarang & institusi sesuai √
Abstrak: terstruktur, IMRAD, informatif √

Pendahuluan: Penelitian sebelumnya, √

alasan, tujuan;  pustaka relevan
Metode: - disain, tempat, sumber data, √
pengukuran kemaknaan, rencana analisis
Hasil: - tabel karakteristik penilaian √
- uji analisis sesuai √
Diskusi: dibahas hasil yang relevan, √
keterbatasan dan dampaknya terhadap hasil,
dihubungkan dengan penelitian terdahulu, 23